|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [1214]
|
Facility
|
OP
|
$122.26
|
|
|
Service Code
|
NDC 7207803400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.37 |
| Max. Negotiated Rate |
$122.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.81
|
| Rate for Payer: Aetna of WY Medicare |
$80.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.37
|
| Rate for Payer: Altius Commercial |
$117.37
|
| Rate for Payer: Beech Street Commercial |
$119.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.38
|
| Rate for Payer: Cash Price |
$85.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.59
|
| Rate for Payer: Cigna of WY Commercial |
$119.81
|
| Rate for Payer: Entrust Commercial |
$116.15
|
| Rate for Payer: First Choice Health Commercial |
$116.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.91
|
| Rate for Payer: HealthUtah PPO |
$122.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.59
|
| Rate for Payer: Multiplan Medicare/VA |
$67.37
|
| Rate for Payer: One Health Plan of WY PPO |
$119.81
|
| Rate for Payer: PacificSource Commercial |
$110.03
|
| Rate for Payer: PHCS PPO |
$119.81
|
| Rate for Payer: Three Rivers PPO |
$91.70
|
| Rate for Payer: TriWest Veterans Administration |
$70.91
|
| Rate for Payer: United Healthcare Commercial |
$106.37
|
| Rate for Payer: United Healthcare Medicare |
$70.91
|
| Rate for Payer: WINHealth Partners Commercial |
$119.81
|
| Rate for Payer: Wise Provider Network Commercial |
$116.15
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [1214]
|
Facility
|
IP
|
$143.29
|
|
|
Service Code
|
NDC 6332372301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$143.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$137.56
|
| Rate for Payer: Altius Commercial |
$137.56
|
| Rate for Payer: Beech Street Commercial |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$117.64
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.99
|
| Rate for Payer: Cigna of WY Commercial |
$140.42
|
| Rate for Payer: Entrust Commercial |
$136.13
|
| Rate for Payer: First Choice Health Commercial |
$136.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$136.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.57
|
| Rate for Payer: HealthUtah PPO |
$143.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.99
|
| Rate for Payer: Multiplan Medicare/VA |
$89.84
|
| Rate for Payer: One Health Plan of WY PPO |
$140.42
|
| Rate for Payer: PacificSource Commercial |
$128.96
|
| Rate for Payer: PHCS PPO |
$140.42
|
| Rate for Payer: Three Rivers PPO |
$107.47
|
| Rate for Payer: TriWest Veterans Administration |
$94.57
|
| Rate for Payer: United Healthcare Commercial |
$124.66
|
| Rate for Payer: United Healthcare Medicare |
$94.57
|
| Rate for Payer: WINHealth Partners Commercial |
$136.13
|
| Rate for Payer: Wise Provider Network Commercial |
$136.13
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [1214]
|
Facility
|
IP
|
$122.26
|
|
|
Service Code
|
NDC 7207803400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.66 |
| Max. Negotiated Rate |
$122.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.37
|
| Rate for Payer: Altius Commercial |
$117.37
|
| Rate for Payer: Beech Street Commercial |
$119.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.38
|
| Rate for Payer: Cash Price |
$85.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.59
|
| Rate for Payer: Cigna of WY Commercial |
$119.81
|
| Rate for Payer: Entrust Commercial |
$116.15
|
| Rate for Payer: First Choice Health Commercial |
$116.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.69
|
| Rate for Payer: HealthUtah PPO |
$122.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.59
|
| Rate for Payer: Multiplan Medicare/VA |
$76.66
|
| Rate for Payer: One Health Plan of WY PPO |
$119.81
|
| Rate for Payer: PacificSource Commercial |
$110.03
|
| Rate for Payer: PHCS PPO |
$119.81
|
| Rate for Payer: Three Rivers PPO |
$91.70
|
| Rate for Payer: TriWest Veterans Administration |
$80.69
|
| Rate for Payer: United Healthcare Commercial |
$106.37
|
| Rate for Payer: United Healthcare Medicare |
$80.69
|
| Rate for Payer: WINHealth Partners Commercial |
$116.15
|
| Rate for Payer: Wise Provider Network Commercial |
$116.15
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [1214]
|
Facility
|
OP
|
$122.26
|
|
|
Service Code
|
NDC 6745719800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.37 |
| Max. Negotiated Rate |
$122.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.81
|
| Rate for Payer: Aetna of WY Medicare |
$80.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.37
|
| Rate for Payer: Altius Commercial |
$117.37
|
| Rate for Payer: Beech Street Commercial |
$119.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.38
|
| Rate for Payer: Cash Price |
$85.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.59
|
| Rate for Payer: Cigna of WY Commercial |
$119.81
|
| Rate for Payer: Entrust Commercial |
$116.15
|
| Rate for Payer: First Choice Health Commercial |
$116.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.91
|
| Rate for Payer: HealthUtah PPO |
$122.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.59
|
| Rate for Payer: Multiplan Medicare/VA |
$67.37
|
| Rate for Payer: One Health Plan of WY PPO |
$119.81
|
| Rate for Payer: PacificSource Commercial |
$110.03
|
| Rate for Payer: PHCS PPO |
$119.81
|
| Rate for Payer: Three Rivers PPO |
$91.70
|
| Rate for Payer: TriWest Veterans Administration |
$70.91
|
| Rate for Payer: United Healthcare Commercial |
$106.37
|
| Rate for Payer: United Healthcare Medicare |
$70.91
|
| Rate for Payer: WINHealth Partners Commercial |
$119.81
|
| Rate for Payer: Wise Provider Network Commercial |
$116.15
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [1214]
|
Facility
|
IP
|
$143.29
|
|
|
Service Code
|
NDC 6332372303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$143.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$137.56
|
| Rate for Payer: Altius Commercial |
$137.56
|
| Rate for Payer: Beech Street Commercial |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$117.64
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.99
|
| Rate for Payer: Cigna of WY Commercial |
$140.42
|
| Rate for Payer: Entrust Commercial |
$136.13
|
| Rate for Payer: First Choice Health Commercial |
$136.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$136.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.57
|
| Rate for Payer: HealthUtah PPO |
$143.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.99
|
| Rate for Payer: Multiplan Medicare/VA |
$89.84
|
| Rate for Payer: One Health Plan of WY PPO |
$140.42
|
| Rate for Payer: PacificSource Commercial |
$128.96
|
| Rate for Payer: PHCS PPO |
$140.42
|
| Rate for Payer: Three Rivers PPO |
$107.47
|
| Rate for Payer: TriWest Veterans Administration |
$94.57
|
| Rate for Payer: United Healthcare Commercial |
$124.66
|
| Rate for Payer: United Healthcare Medicare |
$94.57
|
| Rate for Payer: WINHealth Partners Commercial |
$136.13
|
| Rate for Payer: Wise Provider Network Commercial |
$136.13
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [1214]
|
Facility
|
OP
|
$143.29
|
|
|
Service Code
|
NDC 6332372301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.95 |
| Max. Negotiated Rate |
$143.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.42
|
| Rate for Payer: Aetna of WY Medicare |
$94.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$137.56
|
| Rate for Payer: Altius Commercial |
$137.56
|
| Rate for Payer: Beech Street Commercial |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$117.64
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.99
|
| Rate for Payer: Cigna of WY Commercial |
$140.42
|
| Rate for Payer: Entrust Commercial |
$136.13
|
| Rate for Payer: First Choice Health Commercial |
$136.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$136.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.11
|
| Rate for Payer: HealthUtah PPO |
$143.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.99
|
| Rate for Payer: Multiplan Medicare/VA |
$78.95
|
| Rate for Payer: One Health Plan of WY PPO |
$140.42
|
| Rate for Payer: PacificSource Commercial |
$128.96
|
| Rate for Payer: PHCS PPO |
$140.42
|
| Rate for Payer: Three Rivers PPO |
$107.47
|
| Rate for Payer: TriWest Veterans Administration |
$83.11
|
| Rate for Payer: United Healthcare Commercial |
$124.66
|
| Rate for Payer: United Healthcare Medicare |
$83.11
|
| Rate for Payer: WINHealth Partners Commercial |
$140.42
|
| Rate for Payer: Wise Provider Network Commercial |
$136.13
|
|
|
REM INTERROG PM/LDLS PM <90 D PHYS/QHP
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 93294
|
| Hospital Charge Code |
93294
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.92
|
| Rate for Payer: Aetna of WY Medicare |
$28.15
|
| Rate for Payer: Beech Street Commercial |
$98.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.88
|
| Rate for Payer: Cigna of WY Commercial |
$101.92
|
| Rate for Payer: First Choice Health Commercial |
$93.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.15
|
| Rate for Payer: HealthUtah PPO |
$104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.88
|
| Rate for Payer: Multiplan Medicare/VA |
$23.93
|
| Rate for Payer: One Health Plan of WY PPO |
$101.92
|
| Rate for Payer: PacificSource Commercial |
$93.60
|
| Rate for Payer: PHCS PPO |
$98.80
|
| Rate for Payer: Three Rivers PPO |
$78.00
|
| Rate for Payer: TriWest Veterans Administration |
$28.15
|
| Rate for Payer: United Healthcare Commercial |
$90.48
|
| Rate for Payer: United Healthcare Medicare |
$28.15
|
| Rate for Payer: WINHealth Partners Commercial |
$98.80
|
|
|
REMOVAL ANKLE IMPLANT
|
Professional
|
Both
|
$2,959.00
|
|
|
Service Code
|
HCPCS 27704
|
| Hospital Charge Code |
27704
|
| Min. Negotiated Rate |
$469.40 |
| Max. Negotiated Rate |
$2,959.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,899.82
|
| Rate for Payer: Aetna of WY Medicare |
$552.23
|
| Rate for Payer: Beech Street Commercial |
$2,811.05
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,870.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,899.82
|
| Rate for Payer: First Choice Health Commercial |
$2,663.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,811.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$552.23
|
| Rate for Payer: HealthUtah PPO |
$2,959.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,870.23
|
| Rate for Payer: Multiplan Medicare/VA |
$469.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,899.82
|
| Rate for Payer: PacificSource Commercial |
$2,663.10
|
| Rate for Payer: PHCS PPO |
$2,811.05
|
| Rate for Payer: Three Rivers PPO |
$2,219.25
|
| Rate for Payer: TriWest Veterans Administration |
$552.23
|
| Rate for Payer: United Healthcare Commercial |
$2,574.33
|
| Rate for Payer: United Healthcare Medicare |
$552.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2,515.15
|
|
|
REMOVAL ANTERIOR INSTRUMENTATION
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 22855
|
| Hospital Charge Code |
22855
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$1,058.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,058.47
|
| Rate for Payer: Beech Street Commercial |
$365.75
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: First Choice Health Commercial |
$346.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,058.47
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$899.70
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PHCS PPO |
$365.75
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,058.47
|
| Rate for Payer: United Healthcare Commercial |
$334.95
|
| Rate for Payer: United Healthcare Medicare |
$1,058.47
|
| Rate for Payer: WINHealth Partners Commercial |
$327.25
|
|
|
REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
67938
|
| Min. Negotiated Rate |
$97.04 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$580.16
|
| Rate for Payer: Aetna of WY Medicare |
$114.16
|
| Rate for Payer: Beech Street Commercial |
$562.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$574.24
|
| Rate for Payer: Cigna of WY Commercial |
$580.16
|
| Rate for Payer: First Choice Health Commercial |
$532.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$562.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.16
|
| Rate for Payer: HealthUtah PPO |
$592.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$574.24
|
| Rate for Payer: Multiplan Medicare/VA |
$97.04
|
| Rate for Payer: One Health Plan of WY PPO |
$580.16
|
| Rate for Payer: PacificSource Commercial |
$532.80
|
| Rate for Payer: PHCS PPO |
$562.40
|
| Rate for Payer: Three Rivers PPO |
$444.00
|
| Rate for Payer: TriWest Veterans Administration |
$114.16
|
| Rate for Payer: United Healthcare Commercial |
$515.04
|
| Rate for Payer: United Healthcare Medicare |
$114.16
|
| Rate for Payer: WINHealth Partners Commercial |
$503.20
|
|
|
REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES
|
Professional
|
Both
|
$1,730.00
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
20694
|
| Min. Negotiated Rate |
$284.35 |
| Max. Negotiated Rate |
$1,730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,695.40
|
| Rate for Payer: Aetna of WY Medicare |
$334.53
|
| Rate for Payer: Beech Street Commercial |
$1,643.50
|
| Rate for Payer: Cash Price |
$1,211.00
|
| Rate for Payer: Cash Price |
$1,211.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,678.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,695.40
|
| Rate for Payer: First Choice Health Commercial |
$1,557.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,643.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$334.53
|
| Rate for Payer: HealthUtah PPO |
$1,730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,678.10
|
| Rate for Payer: Multiplan Medicare/VA |
$284.35
|
| Rate for Payer: One Health Plan of WY PPO |
$1,695.40
|
| Rate for Payer: PacificSource Commercial |
$1,557.00
|
| Rate for Payer: PHCS PPO |
$1,643.50
|
| Rate for Payer: Three Rivers PPO |
$1,297.50
|
| Rate for Payer: TriWest Veterans Administration |
$334.53
|
| Rate for Payer: United Healthcare Commercial |
$1,505.10
|
| Rate for Payer: United Healthcare Medicare |
$334.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,470.50
|
|
|
REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
65205
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$27.90
|
| Rate for Payer: Beech Street Commercial |
$144.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: First Choice Health Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.90
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$23.72
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$144.40
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$27.90
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$27.90
|
| Rate for Payer: WINHealth Partners Commercial |
$129.20
|
|
|
REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$2,038.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
27372
|
| Min. Negotiated Rate |
$331.22 |
| Max. Negotiated Rate |
$2,038.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,997.24
|
| Rate for Payer: Aetna of WY Medicare |
$389.67
|
| Rate for Payer: Beech Street Commercial |
$1,936.10
|
| Rate for Payer: Cash Price |
$1,426.60
|
| Rate for Payer: Cash Price |
$1,426.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,976.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,997.24
|
| Rate for Payer: First Choice Health Commercial |
$1,834.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,936.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.67
|
| Rate for Payer: HealthUtah PPO |
$2,038.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,976.86
|
| Rate for Payer: Multiplan Medicare/VA |
$331.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,997.24
|
| Rate for Payer: PacificSource Commercial |
$1,834.20
|
| Rate for Payer: PHCS PPO |
$1,936.10
|
| Rate for Payer: Three Rivers PPO |
$1,528.50
|
| Rate for Payer: TriWest Veterans Administration |
$389.67
|
| Rate for Payer: United Healthcare Commercial |
$1,773.06
|
| Rate for Payer: United Healthcare Medicare |
$389.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,732.30
|
|
|
REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$2,038.00
|
|
|
Service Code
|
HCPCS 27372 80
|
| Hospital Charge Code |
27372
|
| Min. Negotiated Rate |
$331.22 |
| Max. Negotiated Rate |
$2,038.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,997.24
|
| Rate for Payer: Aetna of WY Medicare |
$389.67
|
| Rate for Payer: Beech Street Commercial |
$1,936.10
|
| Rate for Payer: Cash Price |
$1,426.60
|
| Rate for Payer: Cash Price |
$1,426.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,976.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,997.24
|
| Rate for Payer: First Choice Health Commercial |
$1,834.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,936.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.67
|
| Rate for Payer: HealthUtah PPO |
$2,038.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,976.86
|
| Rate for Payer: Multiplan Medicare/VA |
$331.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,997.24
|
| Rate for Payer: PacificSource Commercial |
$1,834.20
|
| Rate for Payer: PHCS PPO |
$1,936.10
|
| Rate for Payer: Three Rivers PPO |
$1,528.50
|
| Rate for Payer: TriWest Veterans Administration |
$389.67
|
| Rate for Payer: United Healthcare Commercial |
$1,773.06
|
| Rate for Payer: United Healthcare Medicare |
$389.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,732.30
|
|
|
REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$2,038.00
|
|
|
Service Code
|
HCPCS 27372 AS
|
| Hospital Charge Code |
27372
|
| Min. Negotiated Rate |
$331.22 |
| Max. Negotiated Rate |
$2,038.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,997.24
|
| Rate for Payer: Aetna of WY Medicare |
$389.67
|
| Rate for Payer: Beech Street Commercial |
$1,936.10
|
| Rate for Payer: Cash Price |
$1,426.60
|
| Rate for Payer: Cash Price |
$1,426.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,976.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,997.24
|
| Rate for Payer: First Choice Health Commercial |
$1,834.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,936.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.67
|
| Rate for Payer: HealthUtah PPO |
$2,038.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,976.86
|
| Rate for Payer: Multiplan Medicare/VA |
$331.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,997.24
|
| Rate for Payer: PacificSource Commercial |
$1,834.20
|
| Rate for Payer: PHCS PPO |
$1,936.10
|
| Rate for Payer: Three Rivers PPO |
$1,528.50
|
| Rate for Payer: TriWest Veterans Administration |
$389.67
|
| Rate for Payer: United Healthcare Commercial |
$1,773.06
|
| Rate for Payer: United Healthcare Medicare |
$389.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,732.30
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
28192
|
| Min. Negotiated Rate |
$257.80 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,587.60
|
| Rate for Payer: Aetna of WY Medicare |
$303.29
|
| Rate for Payer: Beech Street Commercial |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,134.00
|
| Rate for Payer: Cash Price |
$1,134.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,571.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,587.60
|
| Rate for Payer: First Choice Health Commercial |
$1,458.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,539.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.29
|
| Rate for Payer: HealthUtah PPO |
$1,620.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,571.40
|
| Rate for Payer: Multiplan Medicare/VA |
$257.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,587.60
|
| Rate for Payer: PacificSource Commercial |
$1,458.00
|
| Rate for Payer: PHCS PPO |
$1,539.00
|
| Rate for Payer: Three Rivers PPO |
$1,215.00
|
| Rate for Payer: TriWest Veterans Administration |
$303.29
|
| Rate for Payer: United Healthcare Commercial |
$1,409.40
|
| Rate for Payer: United Healthcare Medicare |
$303.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,377.00
|
|
|
REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
28190
|
| Min. Negotiated Rate |
$109.88 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$677.18
|
| Rate for Payer: Aetna of WY Medicare |
$129.27
|
| Rate for Payer: Beech Street Commercial |
$656.45
|
| Rate for Payer: Cash Price |
$483.70
|
| Rate for Payer: Cash Price |
$483.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$670.27
|
| Rate for Payer: Cigna of WY Commercial |
$677.18
|
| Rate for Payer: First Choice Health Commercial |
$621.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$656.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.27
|
| Rate for Payer: HealthUtah PPO |
$691.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$670.27
|
| Rate for Payer: Multiplan Medicare/VA |
$109.88
|
| Rate for Payer: One Health Plan of WY PPO |
$677.18
|
| Rate for Payer: PacificSource Commercial |
$621.90
|
| Rate for Payer: PHCS PPO |
$656.45
|
| Rate for Payer: Three Rivers PPO |
$518.25
|
| Rate for Payer: TriWest Veterans Administration |
$129.27
|
| Rate for Payer: United Healthcare Commercial |
$601.17
|
| Rate for Payer: United Healthcare Medicare |
$129.27
|
| Rate for Payer: WINHealth Partners Commercial |
$587.35
|
|
|
REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
30310
|
| Min. Negotiated Rate |
$173.24 |
| Max. Negotiated Rate |
$727.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$712.46
|
| Rate for Payer: Aetna of WY Medicare |
$203.81
|
| Rate for Payer: Beech Street Commercial |
$690.65
|
| Rate for Payer: Cash Price |
$508.90
|
| Rate for Payer: Cash Price |
$508.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$705.19
|
| Rate for Payer: Cigna of WY Commercial |
$712.46
|
| Rate for Payer: First Choice Health Commercial |
$654.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$690.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.81
|
| Rate for Payer: HealthUtah PPO |
$727.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$705.19
|
| Rate for Payer: Multiplan Medicare/VA |
$173.24
|
| Rate for Payer: One Health Plan of WY PPO |
$712.46
|
| Rate for Payer: PacificSource Commercial |
$654.30
|
| Rate for Payer: PHCS PPO |
$690.65
|
| Rate for Payer: Three Rivers PPO |
$545.25
|
| Rate for Payer: TriWest Veterans Administration |
$203.81
|
| Rate for Payer: United Healthcare Commercial |
$632.49
|
| Rate for Payer: United Healthcare Medicare |
$203.81
|
| Rate for Payer: WINHealth Partners Commercial |
$617.95
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
30300
|
| Min. Negotiated Rate |
$102.37 |
| Max. Negotiated Rate |
$737.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$722.26
|
| Rate for Payer: Aetna of WY Medicare |
$120.44
|
| Rate for Payer: Beech Street Commercial |
$700.15
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$714.89
|
| Rate for Payer: Cigna of WY Commercial |
$722.26
|
| Rate for Payer: First Choice Health Commercial |
$663.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$700.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.44
|
| Rate for Payer: HealthUtah PPO |
$737.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$714.89
|
| Rate for Payer: Multiplan Medicare/VA |
$102.37
|
| Rate for Payer: One Health Plan of WY PPO |
$722.26
|
| Rate for Payer: PacificSource Commercial |
$663.30
|
| Rate for Payer: PHCS PPO |
$700.15
|
| Rate for Payer: Three Rivers PPO |
$552.75
|
| Rate for Payer: TriWest Veterans Administration |
$120.44
|
| Rate for Payer: United Healthcare Commercial |
$641.19
|
| Rate for Payer: United Healthcare Medicare |
$120.44
|
| Rate for Payer: WINHealth Partners Commercial |
$626.45
|
|
|
REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$759.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
20520
|
| Min. Negotiated Rate |
$122.31 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$743.82
|
| Rate for Payer: Aetna of WY Medicare |
$143.89
|
| Rate for Payer: Beech Street Commercial |
$721.05
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$736.23
|
| Rate for Payer: Cigna of WY Commercial |
$743.82
|
| Rate for Payer: First Choice Health Commercial |
$683.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.89
|
| Rate for Payer: HealthUtah PPO |
$759.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$736.23
|
| Rate for Payer: Multiplan Medicare/VA |
$122.31
|
| Rate for Payer: One Health Plan of WY PPO |
$743.82
|
| Rate for Payer: PacificSource Commercial |
$683.10
|
| Rate for Payer: PHCS PPO |
$721.05
|
| Rate for Payer: Three Rivers PPO |
$569.25
|
| Rate for Payer: TriWest Veterans Administration |
$143.89
|
| Rate for Payer: United Healthcare Commercial |
$660.33
|
| Rate for Payer: United Healthcare Medicare |
$143.89
|
| Rate for Payer: WINHealth Partners Commercial |
$645.15
|
|
|
REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,864.00
|
|
|
Service Code
|
HCPCS 27090
|
| Hospital Charge Code |
27090
|
| Min. Negotiated Rate |
$682.22 |
| Max. Negotiated Rate |
$2,864.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,806.72
|
| Rate for Payer: Aetna of WY Medicare |
$802.61
|
| Rate for Payer: Beech Street Commercial |
$2,720.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,778.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,806.72
|
| Rate for Payer: First Choice Health Commercial |
$2,577.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,720.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$802.61
|
| Rate for Payer: HealthUtah PPO |
$2,864.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,778.08
|
| Rate for Payer: Multiplan Medicare/VA |
$682.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,806.72
|
| Rate for Payer: PacificSource Commercial |
$2,577.60
|
| Rate for Payer: PHCS PPO |
$2,720.80
|
| Rate for Payer: Three Rivers PPO |
$2,148.00
|
| Rate for Payer: TriWest Veterans Administration |
$802.61
|
| Rate for Payer: United Healthcare Commercial |
$2,491.68
|
| Rate for Payer: United Healthcare Medicare |
$802.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,434.40
|
|
|
REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,864.00
|
|
|
Service Code
|
HCPCS 27090 AS
|
| Hospital Charge Code |
27090
|
| Min. Negotiated Rate |
$682.22 |
| Max. Negotiated Rate |
$2,864.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,806.72
|
| Rate for Payer: Aetna of WY Medicare |
$802.61
|
| Rate for Payer: Beech Street Commercial |
$2,720.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,778.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,806.72
|
| Rate for Payer: First Choice Health Commercial |
$2,577.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,720.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$802.61
|
| Rate for Payer: HealthUtah PPO |
$2,864.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,778.08
|
| Rate for Payer: Multiplan Medicare/VA |
$682.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,806.72
|
| Rate for Payer: PacificSource Commercial |
$2,577.60
|
| Rate for Payer: PHCS PPO |
$2,720.80
|
| Rate for Payer: Three Rivers PPO |
$2,148.00
|
| Rate for Payer: TriWest Veterans Administration |
$802.61
|
| Rate for Payer: United Healthcare Commercial |
$2,491.68
|
| Rate for Payer: United Healthcare Medicare |
$802.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,434.40
|
|
|
REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,864.00
|
|
|
Service Code
|
HCPCS 27090 80
|
| Hospital Charge Code |
27090
|
| Min. Negotiated Rate |
$682.22 |
| Max. Negotiated Rate |
$2,864.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,806.72
|
| Rate for Payer: Aetna of WY Medicare |
$802.61
|
| Rate for Payer: Beech Street Commercial |
$2,720.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,778.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,806.72
|
| Rate for Payer: First Choice Health Commercial |
$2,577.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,720.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$802.61
|
| Rate for Payer: HealthUtah PPO |
$2,864.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,778.08
|
| Rate for Payer: Multiplan Medicare/VA |
$682.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,806.72
|
| Rate for Payer: PacificSource Commercial |
$2,577.60
|
| Rate for Payer: PHCS PPO |
$2,720.80
|
| Rate for Payer: Three Rivers PPO |
$2,148.00
|
| Rate for Payer: TriWest Veterans Administration |
$802.61
|
| Rate for Payer: United Healthcare Commercial |
$2,491.68
|
| Rate for Payer: United Healthcare Medicare |
$802.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,434.40
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
69210
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$163.66
|
| Rate for Payer: Aetna of WY Medicare |
$31.08
|
| Rate for Payer: Beech Street Commercial |
$158.65
|
| Rate for Payer: Cash Price |
$116.90
|
| Rate for Payer: Cash Price |
$116.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$161.99
|
| Rate for Payer: Cigna of WY Commercial |
$163.66
|
| Rate for Payer: First Choice Health Commercial |
$150.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$158.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.08
|
| Rate for Payer: HealthUtah PPO |
$167.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$161.99
|
| Rate for Payer: Multiplan Medicare/VA |
$26.42
|
| Rate for Payer: One Health Plan of WY PPO |
$163.66
|
| Rate for Payer: PacificSource Commercial |
$150.30
|
| Rate for Payer: PHCS PPO |
$158.65
|
| Rate for Payer: Three Rivers PPO |
$125.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.08
|
| Rate for Payer: United Healthcare Commercial |
$145.29
|
| Rate for Payer: United Healthcare Medicare |
$31.08
|
| Rate for Payer: WINHealth Partners Commercial |
$141.95
|
|
|
REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 69209 50
|
| Hospital Charge Code |
69209
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$15.63
|
| Rate for Payer: Beech Street Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: First Choice Health Commercial |
$126.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.63
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$13.29
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$133.00
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$15.63
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$15.63
|
| Rate for Payer: WINHealth Partners Commercial |
$119.00
|
|
